U.S. patent number 3,760,810 [Application Number 05/205,555] was granted by the patent office on 1973-09-25 for surgical ligating instrument of the endoscope type.
Invention is credited to Marc E. J. Van Hoorn.
United States Patent |
3,760,810 |
Van Hoorn |
September 25, 1973 |
SURGICAL LIGATING INSTRUMENT OF THE ENDOSCOPE TYPE
Abstract
A surgical instrument for ligating internal structures of a
cavity in the human body, such as internal hemorrhoids, by means of
at least one elastic cord comprises two tubes mounted for relative
sliding movement one inside the other, the inner tube protruding at
the front of the outer tube. A grip member is connected to one of
said two tubes and has actuating means to produce a relative
displacement of the outer tube forwardly relative to the inner
tube. The outer tube and/or the inner tube has a greater length
than the depth of the cavity up to the structure to be ligated, so
that it constitutes an endoscope.
Inventors: |
Van Hoorn; Marc E. J.
(Bruxelles, BE) |
Family
ID: |
25647531 |
Appl.
No.: |
05/205,555 |
Filed: |
December 7, 1971 |
Foreign Application Priority Data
|
|
|
|
|
Dec 11, 1970 [BE] |
|
|
97445 |
Jun 1, 1971 [BE] |
|
|
104090 |
|
Current U.S.
Class: |
606/140 |
Current CPC
Class: |
A61B
17/12013 (20130101); A61B 1/31 (20130101); A61B
2017/12018 (20130101); A61B 1/07 (20130101) |
Current International
Class: |
A61B
17/12 (20060101); A61B 1/31 (20060101); A61b
017/12 () |
Field of
Search: |
;128/33A,320,326
;29/235 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Medbery; Aldrich F.
Claims
What I claim is:
1. A surgical instrument for ligating internal structures such as
hemorrhoids and the like within a cavity of the human body by the
application of at least one elastic cord, said instrument
comprising, in combination:
a. an outer hollow tube having a forward end and a rearward
end;
b. an inner hollow tube having a forward end and a rearward end and
coaxially and slidably received within the outer hollow tube
wherein the length of at least one tube exceeds the depth of the
body cavity up to the structure to be ligated, said rearward end of
the inner tube being open;
c. said inner tube further including means for passing illuminating
light therethrough;
d. means for retaining an elastic cord on the forward end of the
inner tube while it protrudes beyond the forward end of the outer
tube;
e. handle means associated with the rear-ward ends of the outer and
inner tubes; and
f. means secured to the handle means for imparting a relative
movement between the outer and inner tubes so that the elastic cord
is caused to slide off of the forward end of the second tube and
attach itself to the structure being ligated.
2. The instrument according to claim 1 wherein the means for
producing the relative movement between the outer and inner tubes
includes a trigger means.
3. The instrument according to claim 2 wherein the handle means
includes a channel formed therein and
a. the handle means is secured to the outer tube; and
b. the trigger means is secured to the inner tube and is movably
received within the channel.
4. The instrument according to claim 3 wherein the handle member
includes:
a. a recess; and
b. a spring blade disposed within the recess for biasing the
trigger means so that the inner tube is pushed in a forward
direction.
5. The instrument according to claim 1 wherein the handle member is
fixed to said outer tube and comprises a spring disposed between
said inner and said outer tube to urge said inner tube in a
rearward direction against an abutment so as to maintain the inner
tube in a position wherein its forward end is located forwardly of
the outer tube forward end, and where in said abutment is
retractable against a spring force by a trigger mounted on said
handle member.
6. The instrument according to claim 1 wherein the handle means is
secured to the inner tube and includes:
a. a pivotal lever;
b. an actuation rod connected at its one end to the outer tube and
disposed at its other end adjacent the pivotal lever; and
c. spring means for biasing the other end of the rod against the
pivotal lever so that the outer tube is urged in a rearward
direction.
7. The instrument according to claim 1 wherein:
a. the inner tube has a smaller length than the depth of said
cavity up to the structure to be ligated; and
b. the outer tube has a forward portion adapted to slidably receive
the inner tube and a conical portion increasing in diameter
rearwardly.
8. The instrument according to claim 1 wherein the handle means is
detachably secured to the outer tube.
9. The instrument according to claim 8 wherein
a. the handle means includes a groove; and
b. the outer tube includes a longitudinal rib of dove-tail shape
for engagement within the groove.
10. The instrument according to claim 9 wherein the groove is
provided with a slit for receiving a trigger means.
11. The instrument of claim 1 including removable dilating means
for facilitating the introduction of the associated tubes with the
elastic cord into the cavity containing the structure to be
ligated.
12. The instrument according to claim 1 wherein the inner tube is
adapted to be closed at its rearward end by a transparent partition
and that the interior of the inner tube is connectable to a vacuum
pump.
13. The instrument according to claim 12 wherein the vacuum pump is
connected by means of a flexible tube to a sleeve which is tightly
secured to the rearward end of the inner tube and which is closed
at its rearward extremity by a transparent partition.
14. The instrument according to claim 13 wherein the tubes
include:
a. a hollow projection inclined in a rearward direction with
respect to the longitudinal axis of the tubes; and
b. an illumination source associated with the hollow projection for
illuminating the structure to be ligated.
15. The instrument according to claim 14 wherein both tubes have a
length greater than the depth of said cavity up to the structure to
be ligated and the hollow projection is formed on the outer
tube.
16. The instrument according to claim 15 wherein the inner tube has
a longitudinal slot located in the region of the hollow projection
on the outer tube to permit propagation of light beams from said
light source into the inner tube.
17. The instrument according to claim 15 wherein the inner tube is
made of a transparent material to permit propagation of light beams
from said light source into the inner tube.
18. The instrument according to claim 17 wherein the forward end of
the transparent tube is formed by a sleeve disposed around the
outer face of the transparent tube to prevent deposition of soiling
substances on the transparent tube.
19. The instrument according to claim 14 wherein the hollow
projection includes:
a. a mass of bundled optical fibers disposed therein;
b. a flexible tube forming an extension thereof; and
c. an intense light source for transmitting light beams through the
flexible tube and the optical fibers.
20. The instrument according to claim 1 further including a sleeve
secured to the rearward end of the inner tube, said sleeve having a
laterally extending hollow portion for connection to an intense
light source.
21. The instrument according to claim 20 wherein a ring of
transparent material is provided on the inner face of the sleeve to
permit propagation of the light beams from said intense light
source toward the forward end of the inner tube and wherein the
ring is covered on its inner face by a metallic film for avoiding a
parasitic diffusion of the light.
22. The instrument according to claim 21 wherein a mass of bundled
optical fibers is disposed in said laterally extending hollow
projection and is connected to said ring of transparent
material.
23. The instrument according to claim 1 wherein the means for
placing an elastic cord on the forward end of the inner tube
includes:
a. a forward conical-shaped portion;
b. an intermediate cylindrical-shaped portion whose diameter is
equal to the greatest diameter of the forward conical-shaped
portion;
c. a rearward cylindrical-shaped portion having a lesser diameter
than and forming an extension of the intermediate
cylindrical-shaped portion;
d. a shoulder on said intermediate cylindrical-shaped portion for
engaging the forward end of the inner tube.
24. The instrument of claim 11 wherein the means for facilitating
the introduction of the associated tubes includes an obturator bar
in sliding engagement with the inner tube and having:
a. a greater length than the depth of said cavity up to the
structure to be ligated;
b. an ogival-shaped extremity protruding at the forward end of the
inner tube; and
c. a rear abutment for engaging the rearward end of the inner tube.
Description
The present invention relates to the treatment of internal and
external parts or structures of the human body by means of a
ligature and concerns more particularly the treatment of
rectosigmoidal lesions such as the hemorrhoids.
It is already known to treat the internal hemorrhoids by ligating
them by means of one or several elastic cords to produce a stoppage
of the circulation and causing the deadening of the hemorrhoid
tissues.
The invention concerns a surgical instrument to ligate even without
anesthesia the internal parts of a cavity of the human body, more
particularly internal hemorrhoids, by means of at least one elastic
cord, and comprises in a known manner two tubes mounted in sliding
relationship one inside the other, the inner tube projecting from
the forward portion of the outer tube, and a handle or grip member
connected to two tubes in order to produce a relative movement of
the outer tube forwardly with respect to the inner tube.
The use of a known instrument of this type by a surgeon on the
inside of a cavity in which a structure is to be ligated,
particularly at the inside of the anal canal, in combination with
an atraumatic clamp for taking hold of the structure to be treated,
necessitates a visual observation of this structure and of the
entire operation at the inside of the cavity. In order to permit
this observation a separate endoscope has been used which is held
by the assistant of the surgeon while the latter proceeds with his
work of effecting a ligature of the structure.
The known instruments present thus the disadvantage of requiring
the continuous presence of an assistant during the entire surgical
operation. This assistant is reduced to a passive function. He
cannot observe personally the cavity and the ligature operation
which takes place, due to the relatively narrow visual field of the
endoscope. It is therefore difficult for the assistant to determine
which position of the endoscope is the most helpful to the surgeon
and therefore the surgeon may be impeded in his handling of the
surgical instrument and of the atraumatic clamp.
An additional disadvantage of these known instruments which must
necessarily be utilized jointly with an endoscope resides in the
fact that they reduce to an appreciable extent the visual field of
the endoscope which they traverse. This constitutes a supplemental
impediment for the surgeon.
The present invention eliminates these inconveniences. For this
purpose the outer tube and/or the inner tube of the surgical
instrument according to the invention has a length which is greater
than the depth of the cavity up to the structure to be ligated.
The instrument according to the invention thus constitutes an
endoscope in the sense that the surgeon is able to observe the
inside of the cavity and structure to be ligated directly through
the two tubes of which one at least projects out of the cavity. The
instrument according to the invention presents thus the advantage
of combining in a single device which can be operated with one hand
at the same time a surgical instrument for ligating an internal
structure and also an endoscope. The instrument according to the
invention thus relieves the surgeon from the requirement of a
separate endoscope and an assistant for handling it. Furthermore,
the doctor may easily orient the instrument to the position which
appears to him the most favorable to observe and seize the
structure to be ligated which constitutes a supplemental advantage
in relation to the known instruments used with a separate endoscope
as described above.
In the particular case concerning the treatment of the internal
hemorrhoids the outer tube and/or the inner tube of the instrument
according to the invention has a length which is greater than the
length of the anal canal so as to constitute a rectoscope.
A supplemental advantage of the instrument according to the
invention resides in the fact that the endoscope which it
constitutes is traversed by no other instrument except the
atraumatic clamp. He obtains thus a relatively large visual field
which is particularly due to the fact that he is independent of the
dimensions of the conventional endoscopes and that the section of
the tubes may have partly, entirely, or in a combination, depending
on the requirement, a cylindrical, oval, conical or flaring form.
Simultaneously the diameter of the sliding tubes may be essentially
greater than the diameter of the sliding tubes of the known
instruments so that in comparison with the known instruments, the
instrument according to the invention permits a more substantial
introduction of tissue into the tube and ligating more tissue
constituting the structure to be treated.
In certain particular cases, especially for the treatment of
internal hemorrhoids the surgeon may sometimes even discard the
atraumatic clamp because the hemorrhoid to be ligated may protrude
into the inner tube of the instrument according to the invention
due to an abdominal hypertension on the part of the patient.
In a particularly advantageous embodiment of the instrument
according to the invention the two aforementioned tubes are closed
at their rear extremity by a transparent partition and they are in
communication with a vacuum pump.
This particular embodiment of the instrument according to the
invention allows the surgeon to operate without the atraumatic
clamp because the structure to be ligated is pulled into the inner
tube of the instrument under the action of the vacuum pump.
This embodiment of the instrument according to the invention allows
also, in combination with a manometer, to determine at what vacuum
a vascular rupture is produced.
According to a preferred embodiment of the instrument according to
the invention the grip member comprising a handle which is designed
so that the hand can be placed around it, this handle being fixed
to the extremity of one of the two aforementioned tubes which has a
greater length than the depth of the cavity and as far as the
structure to be ligated and furthermore a lever which is connected
to the other tube and which is arranged so that it can be actuated
by a finger of that hand. This embodiment is advantageous in that
it permits to take a stronger hold of the instrument and therefore
a more precise functioning.
During the utilization of the instrument according to the invention
the illumination of the cavity and of the structure to be ligated
may be obtained for example by ambiant light in the operating room
or also by means of a frontal lamp of the conventional type carried
by the surgeon.
According to a particular embodiment the instrument according to
the invention is provided with an illuminating device for the
cavity and the structure to be ligated. This illuminating device
can for example comprise a bushing which is fixed transversely to
one of the tubes and which is in communication both with a light
source and with the inside of the tubes.
The characteristic features and greater details of the invention
will become more clearly apparent from the following description
given with reference to the attached drawings which represent, for
the purpose of example only, several specific embodiments of the
instrument according to the invention. In the drawings:
FIG. 1 shows an elevation view, partly broken away, of a first
embodiment of the instrument according to the invention;
FIG. 2 is a section along line II--II of FIG. 1;
FIG. 3 is an elevation view, partly in section, of an auxiliary
part of the instrument according to the invention;
FIG. 4 is an elevation view of an other auxiliary part of the
instrument according to the invention;
FIG. 5 shows the instrument of FIGS. 1 and 2 lodged in a cavity
containing a structure to be ligated, and utilized jointly with an
atraumatic clamp;
FIG. 6 is a view similar to FIG. 2 of a modification of the
embodiment of the instrument of FIGS. 1 and 2;
FIG. 7 shows a modification of the instrument of FIG. 6;
FIG. 8 is a partial view in axial section of a second embodiment of
the instrument according to the invention;
FIG. 9 is an elevation view, partly broken away, of a third
embodiment of the instrument according to the invention;
FIG. 9a shows a partial view in axial section of a modification of
the embodiment of the instrument of FIG. 9;
FIG. 10 shows an elevation view, partly broken away, of a fourth
embodiment of the instrument according to the invention;
FIG. 10a shows a partial view in axial section of a modification of
the embodiment of the instrument of FIG. 10;
FIG. 11 is a partial elevation view, partly broken away, of a fifth
embodiment of the instrument according to the invention;
FIG. 12 is an elevation view, partly broken away, of a sixth
embodiment of the invention;
FIG. 13 is a section along line XIII--XIII of FIG. 12;
FIG. 14 is a section along line XIV--XIV of FIG. 12;
FIG. 15 is an elevation view, partly broken away, of an
advantageous embodiment of the instrument according to the
invention, lodged in a cavity containing a structure to be
ligated.
Referring to the drawings, like numerals designate like parts
throughout the different views. According to a first embodiment of
the invention represented in FIGS. 1 and 2 the surgical instrument
according to the invention comprises a tube 1 having the form of a
truncated cone and is of a length which is greater than the depth
of a cavity containing a structure to be ligated. For example in
the particular case of an instrument to be used for ligating
internal structures in the sigmoidal flexure of the colon, such as
internal hemorrhoids, the tube 1 has a greater length than the
length of the anal canal. In the case of an instrument to be used
for ligating structures of the oesophagus, such as the polyps, the
tube 1 has a length which is greater than the length of the
oesophagus up to the cardia.
The tube 1 is fixed at one extremity to a handle 4 directed
rearward and downward. This handle is shaped substantially like the
butt of a gun in order to facilitate its gripping by the hand. For
this purpose it presents advantageously at the front portion
recesses 5 for lodging the fingers and rearwardly a recess 31 for
the ball of the thumb.
A tube 2 is mounted for sliding movement on the inside of tube 1.
It presents at the rear portion an abutment 15 designed to rest
against the rear extremity of the outer tube 1 when it is received
completely in tube 1. The inner tube 2 is slightly longer than the
outer tube 1 so as to present a part 14 protruding in front of tube
1 when it is received fully in tube 1. This forward part 14 of tube
2 is designed to receive one or more elastic cords 29 to ligate an
internal structure, in this case a hemorrhoid.
An arrow shaped groove 6 is cut into handle 4 at its upper part and
extends from the rear to the front and upwardly. The groove 6
provides a channel for a lever 3 fixed to the rear extremity of the
inner tube 2 and extending downwardly. The position of lever 3 on
tube 2 and its form are arranged so that when tube 2 is received
completely in tube 1 this lever 3 protrudes forwardly from the
handle 4 like the trigger of a gun. Tube 2 is usually received
completely in tube 1 by means of a spring blade 9 mounted on a
support or base 10 and arranged in a recess 8 of handle 4 so as to
be applied elastically against lever 3. The recess 8 extends
preferably up to the lower extremity of handle 4 in order to permit
the retraction of blade 9 from this recess so that tube 2 may be
withdrawn and pulled from tube 1. A slot 11 may be cut into the
support 10 to allow the insertion of a finger nail in order to
facilitate the withdrawal of the spring blade 9.
The instrument of FIGS. 1 and 2 is equipped with an illuminating
device for the inside of tube 2. For this purpose the outer tube 1
carries at its rear portion a lateral bushing 17 directed obliquely
rearwardly and provided with an electric bulb 20. Opposite bushing
17 the outer tube 1 is perforated to provide an opening 18 and the
inner tube 2 is perforated to provide an opening 19 having the form
of a button hole which is elongated in the axial direction of tubes
1 and 2. The length of this opening 19 is chosen so as to assure
constantly the illumination of the inside of tube 2 from the bulb
20 while tube 2 is received in tube 1 for a length which is equal
to its forward part 14 which projects in front of tube 1. The inner
partition of tube 2 is preferably polished so as to reflect the
light beams emanating from bulb 20 forwardly of tube 17.
The surgical instrument represented in FIGS. 1 and 2 is utilized
without anesthesia in the following manner:
When the inner tube 2 is drawn fully into outer tube 1 under the
action of spring 9, one or more elastic cords 29 are placed around
the forward part 14 of tube 2 which protrudes at the front of outer
tube 1. For this purpose one may advantageously make use of an
auxiliary member such as represented in FIG. 3. This auxiliary
member comprises according to the invention a conical part 21
followed by a cylindrical part 22 whose diameter is essentially
equal to the outer diameter of the forward part 14 of tube 2. A
cylindrical extension 23 is integral with part 22 and may be
engaged into the forward part 14 of tube 2, in order to hold the
auxiliary member against this tube. A shoulder 80 is provided on
the cylindrical part 22 around the cylindrical extension 23 in
order to permit the engagement of the beveled forward edge of tube
2. In this manner the passing of an elastic cord 29 from the
cylindrical part 22 on the forward part 14 of tube 2 is
facilitated.
As soon as one or several elastic cords 29 have been placed on the
extremity 14 of tube 2 the auxiliary member of FIG. 3 is withdrawn
and thereafter a stopper bar 28 (shown in FIG. 4) is introduced
from the back into groove or recess 6 until its rear abutment 30 is
in position against the rear extremity of tube 2, its forward
extremity 26 formed like a pointed arch whose diameter is
essentially the same as the inner diameter of groove or recess 6
protruding in that position from the front of tube 2. A handle 27
facilitates the gripping of the stopper bar 28 and its introduction
into tube 2.
The operator may thereafter introduce the instrument into cavity 32
containing the structure to be treated for example into the rectal
cavity through the anus (FIG. 5). After having withdrawn the
stopper bar 28 the operator may easily observe cavity 32 and the
structure 34 to be ligated through tube 2 as through an endoscope,
the bulb 20 having been illuminated in the lateral bushing 17.
While the operator holds handle 4 of the instrument firmly in one
hand he introduces with the other hand an atraumatic clamp 33
through tube 2 in order to seize the structure 34 to be ligated
(for example a hemorrhoid or a polyp) and drawing it on the inside
of tube 2. The operator actuates subsequently lever 3 in the
direction of arrow X (FIG. 1), against the effect of spring 9 by
means of the index finger of the hand gripping handle 4, in the
same manner as if he pressed the trigger of a gun. This produces a
retraction of tube 2 to the inside of tube 1, so that the elastic
cord 29 is pushed beyond tube 2 and closes around structure 34.
The elongated lateral opening 19 provided through the partition of
the inner tube 2 permits an illumination of the inside of this tube
from bushing 17 for the entire duration of the operation even after
the operator has actuated lever 3.
In FIG. 6 a modification of the instrument of FIGS. 1 and 2 is
illustrated.
In the instrument shown in this FIG. 6 the inner tube 2 is made of
a transparent material, for example glass. In this manner the
requirement of making an opening 19 for the propagation of the
light beams emanating from the light source 20 is eliminated. In
choosing for tube 2 a transparent material having a refraction
index which is higher than that of air, for example glass, this
tube 2 may advantageously constitute, with a sufficient inclination
of bushing 17, a propagation center of the light beams toward the
structure to be ligated.
If necessary the forward part 14 of transparent tube 2 may be
formed by a coaxial sleeve 35 extending the outer face of this tube
(FIG. 7) forwardly. This sleeve 35 prevents the deposit of soiling
substances on the forward extremity of the transparent tube 2. A
rearward ring 37 may be provided in this case in order to assure an
adequate sliding of this tube 2 in the outer tube 1.
The sleeve 35 may also be extended if desired as far as the bushing
17 and perforated opposite the bushing to provide an opening in the
form of a button hole similar to opening 19 of the instrument shown
in FIGS. 1 and 2.
In a modification the two faces, the inner face and the outer face,
of the transparent tube 2 may be covered by a jacket or a metallic
film, for example a tin film, in order to prevent a diffusion of
the light from the tube 2.
In the embodiments of FIGS. 1, 2 and 6 the lateral bushing 17 may,
in a modification, contain a mass of bundled optical fibers, for
example glass fibers, suitable of constituting a propagation center
of the light beams toward the tube 2.
In FIG. 8 is represented partially a particular embodiment of the
instrument according to the invention permitting an intense
illumination of the examined cavity and the structure to be
ligated. For this purpose the instrument is provided with a sleeve
38 which is designed to be locked or screwed in the back part of
the inner tube 2. This sleeve 38 is perforated laterally to form an
opening 18 around which a lateral bushing 17 is fixed. On the
threaded extremity of this bushing 17 the extremity of a flexible
tube 39 is screwed which is connected to an intense light source
not shown. This intense light source may, for example, be produced
by means of an electric arc. In order to permit the propagation of
the light beams toward tube 2 a mass of bundled optical fibers is
disposed in the flexible tube 39 and bushing 17. This mass of
optical fibers is connected to a ring 68 disposed on the inside of
sleeve 38 and made of a transparent material, susceptible of
propagating a light beam, for example of glass. This ring is
advantageously formed by the prolongation of the optical fibers
contained in bushing 17. Its inner face, which is directed toward
the axis of tube 2, may be covered by a partition or metallic film
to avoid a parasitic diffusion of the light.
In the embodiment shown in FIG. 9 the inner tube 2 of the
instrument according to the invention is shorter than the outer
tube 1 and disposed in the forward part of the latter. The tube 2
is fixed to a rod 40 traversing the tube 1 preferably along its
wall and bent at 41 in the rearward portion. The bent portion 41 of
rod 40 is urged by the effect of spring 42 against a lever 43 and
an abutment 44 which is integral with the handle 4. The lever 43 is
pivotally mounted at 45 on handle 4 and is designed to be actuated
at 46 in the direction of the arrow Y by the thumb of the hand
holding the handle 4 so as to withdraw the rod 40 and the tube 2
against the force of spring 42.
In this second embodiment of the surgical instrument according to
the invention the stopper bar 28 (not shown) must necessarily
present a longitudinal groove for the travel of rod 40.
In a modification a longitudinal groove may be cut into the wall of
the outer tube 1 to provide a passage for rod 14 so that this rod
does not extend into tube 1. In this case the aforementioned groove
of the stopper bar 28 is no longer necessary.
According to an other modification of the surgical instrument
according to FIG. 9 the handle 4 shows in its upper part an arrow
shaped recess similar to recess 6 of the embodiment of FIGS. 1 and
2. The bent portion 41 of rod 40 traverses this recess so as to
extend forwardly from handle 4 in a manner of a gun trigger. The
spring 42 may in this case be advantageously replaced by a spring
which is similar to flexible blade 9 of the embodiment of FIGS. 1
and 2.
FIG. 9a is a section view of a partial modification of the
instrument of FIG. 9 in which the outer tube has in its forward
part a suitable diameter to allow the sliding of tube 2 and in its
rearward part internal conical walls which facilitate the
illumination, the examination and the introduction of a clamp. The
rod 40 is angled in accordance with tube 2 and the stopper bar is
adapted to the diameters of tubes 1 and 2. The rearward part of
tube 1 may be modified to have an oval or flared shape.
FIG. 10 shows a special embodiment of the instrument according to
the invention in which the outer tube has a smaller length than the
depth of the cavity containing the structure to be ligated.
In the instrument of FIG. 10 the inner tube 2 has a greater length
than the depth of the aforementioned cavity up to the structure to
be ligated. It is fixed in the back on a handle 4 which is
analogous to the handle used with the instruments described
above.
The outer tube 1 is mounted for sliding movement around the forward
part 14 of the inner tube 2.
A rod 49 is fixed to tube 1 and disposed along the inner face of
tube 2. An elongated opening 47 is cut into the wall of tube 2
facing tube 1 to provide a passage of the forward bent part of rod
49. This opening 47 extends preferably up to the forward extremity
of tube 2 so as to permit the removal of tube 1 as described
above.
The rod 49 is extended in the back by means of a bent portion 50
arranged in an arrow shaped recess 6 cut into the upper part of the
handle 4 and extending upwardly and rearwardly.
The grip member of the instrument comprises a lever 54 rotated on a
pivot 55 of handle 4 and interposed between the bent portion 50 and
a fixed abutment 56. The lower part of the lever 54 traverses the
recess 6 in front of the handle so that it can be actuated by a
finger of the hand in the direction of the arrow Y.
The tube 1 is returned to the rear by means of a spring 51 disposed
in a tubular slot 52 of the handle 4 and compressed against the
aforementioned bent portion 50. A screw 54 permits access to spring
51.
The bent portion 50 is preferably fixed to rod 49 by means of a
threaded sleeve 57 so as to permit the removal of tube 1 for the
purpose of cleaning the instrument.
The FIG. 10a shows a section of a partial modification of the
embodiment of the instrument of FIG. 10, in which the inner tube 2
presents at its forward part a diameter suitable to permit a
sliding of tube 1 and at its rear part internal conical walls. The
rod 49 is angled to correspond with tube 1 and is lodged in a
groove cut into tube 2. The rear part of tube 2 may also have an
oval or flared shape.
In the embodiment according to FIG. 11 the instrument according to
the invention comprises a handle 4 fixed to the rear part of outer
tube 1 whose length is greater than the depth of the cavity to be
examined. The inner tube 2 is extended at the back of tube 1 by an
abutment 69. A spring 70 is compressed between this abutment 69 and
an abutment 71 fixed to tube 1 or to handle 4 so as to urge tube 2
toward the back into tube 1.
A rod 72 is mounted for sliding movement in a slot 73 of handle 4.
A spring 74 is interposed between the bottom of slot 73 and rod 72
so as to urge rod 72 against a wall portion 75 of the inner tube 2
where it constitutes an abutment preventing a withdrawal of tube 2
under the effect of spring 70.
A lever 76 urged by a spring 77 so as to extend forwardly of the
handle 4 carries a beveled element 78 arranged against a wall
portion 79 of the rod or abutment 72.
In order to move the lever 76 in the direction of the arrow Z the
beveled element 78 pushes rod 72 against the force of return spring
74 and moves it away from the retaining wall 75 to liberate thus
tube 2 which may return freely into the outer tube 1 under the
effect of spring 70.
The return of tube 2 into tube 1 is limited by the abutment 69
cooperating with the rod 72.
The FIGS. 12, 13 and 14 show a particularly interesting embodiment
of the instrument according to the invention in which the assembly
of the two tubes 1 and 2 is fixed so as to be removable from handle
4.
For this purpose the outer tube 1 carries adjacent its rear
extremity a longitudinal rib 58 presenting in transverse section a
dove tail shape.
The handle 4,which can be made for example of steel and similar to
the handle of the instruments shown in FIGS. 1 and 2, presents in
its upper part a reinforced forward zone 59 to support the rear
part of tube 1. A longitudinal groove 60 of dove tail shape is
provided in this part 59 in order to engage the corresponding rib
58 of tube 1. Abutments 61 assure the proper engagement of the
tubes 1 and 2 on the handle 4.
The upper forward zone 59 of the handle 4 is perforated in the axis
of the groove 60 by a slit 68 for the passage of lever 3 fixed to
tube 2. In this manner the assembly of the two tubes 1 and 2 locked
one inside the other may be put in position on handle 4 by a single
movement from front to back. This assembly may in an analogous
manner be withdrawn from handle 4 with a single back to front
movement.
This embodiment of the instrument according to the invention allows
to make all the tubes of an inexpensive material, for example of
synthetic material, in which case the tubes would be used only one
time. They may be furnished already disposed one inside the other
with an elastic band 29 placed around the extremity of tube 2, and
completely enclosed in a sterilized package.
FIG. 15 concerns an embodiment which is particularly advantageous
for a surgical instrument according to the invention.
In the instrument of FIG. 15 the tubes 1 and 2 are extended toward
the back by means of a sleeve 62 locked or threaded into the back
part 15 of tube 2. This sleeve 62 is closed by a transparent screen
63 made for example of glass. A joint 64 may be provided to assure
a good seal between the screen 63 and the sleeve 62.
The sleeve 62 is perforated to form a lateral opening 65 and a bent
connecting tube 66 is attached to the periphery of this opening.
The tube 66 is adapted to be connected to a flexible tube 67 which
communicates with a vacuum pump not shown.
When the instrument of FIG. 15 is lodged in a cavity containing a
structure to be ligated, for example the anal canal, the
transparent screen permits an observation of this cavity and
orienting the instrument carefully so that the extremity 14 of tube
2 is placed in the vicinity of a structure 34 to be ligated. The
vacuum pump may be actuated which results in pulling the structure
43 into tube 2.
A manometer not shown may be mounted on tube 67 and permits to
regulate the vacuum in the cavity to the optimum value.
The instrument according to the invention illustrated in FIG. 15
allows the operator to work without a clamp whose atraumatic
character is only relative and therefore leaves him one hand free.
Furthermore, this instrument permits making the ligature operation
less coarse. It permits further a control of the bleeding tendency
of the blood vessels in the cavity, for example of the hemorrhoids,
by measuring the vacuum capable of provoking a bleeding in the
cavity.
It is obvious to the persons skilled in the art that the invention
is not limited to the embodiments described above and that suitable
modifications may be made without leaving the scope of the
invention as defined by the following claims.
* * * * *